Pamela Payne Foster

Older African Americans’ management of HIV/AIDS stigma

Abstract The purpose of this study was to describe HIV/AIDS-related stigma in older African Americans living in the South, a population disproportionately affected by HIV/AIDS. Four focus groups were conducted with 24 men and women over 50 years old and a confirmed diagnosis of HIV. The focus group discussions were audiotaped and transcribed for analysis. Additionally, two stigma instruments, Self-Perceptions of HIV Stigma, and Stigma Impact of HIV, were used to enhance the qualitative data from the focus groups. Constant comparative data analysis of the focus group discussions resulted in four themes related to HIV/AIDS stigma: (1) disclosure; (2) stigma experiences; (3) need for HIV/AIDS education; and (4) acceptance of the disease. Strategies to prevent or decrease anticipated stigma were described, such as selective or non-disclosure and not receiving care where they lived. The stigma instruments indicated that the participants had experienced the most stigma related to their internalized shame about having HIV disease, and had experienced little or no direct stigma. The study findings have implications for designing prevention programs, and strategies to improve social support for this age group.

Reasons for HIV Disclosure and Non-Disclosure: An Exploratory Study of Rural African American Men

Disclosure of ones HIV status to others is an important decision. There are benefits and risks to be considered. Also decisions must be made about the recipients of the disclosure. This study explored reasons for disclosure and non-disclosure among rural African American men in the south. Audiotaped interviews were conducted with 40 men. The most common reasons for disclosure were to relieve stress, satisfy the need to tell, help others, and to receive support. The most common reasons for non-disclosure were the fear of negative reaction or stigma, the fear of the disclosure recipient telling others, a belief that there was no need to tell, not being ready to tell, and not wanting to burden others with the disclosure.

Assessment of HIV/AIDS Prevention of Rural African American Baptist Leaders: Implications for Effective Partnerships for Capacity Building in American Communities

PURPOSE This exploratory study sought to elicit information from rural Baptist leaders about their interest in HIV prevention activities within their congregation and other influencers in their human deficiency virus (HIV) prevention activities based on their geographical residence (urban vs rural). METHODS This study utilized both qualitative (in-depth interviews, N = 8) and quantitative (written survey, N = 56) methodologies (mixed method) in order to obtain pertinent information. A ministerial liaison was hired to assist in recruitment of participants within a statewide Baptist conference. Written surveys were distributed at a statewide meeting. RESULTS The majority of participants (N = 50) in this study (89.3%) were receptive to conducting HIV/AIDS prevention activities within their congregations. The study also revealed rural/urban differences, including: interest in HIV/AIDS prevention, direct experiences with infected persons, or whether churches have a health-related ministry. Positive influencers of HIV/AIDS prevention in rural church leaders included either the participant or their spouse being in a health-related occupation, migratory patterns from larger metropolitan areas in other areas of the country to the rural south, and whether the church has a health-related ministry. CONCLUSIONS Findings from this study are significant for a variety of reasons, including use of faith-based models for HIV/ AIDS capacity building and use of potential influencers on HIV/AIDS prevention in African Americans in the rural Deep South, where the epidemic is growing fastest. Future implications of this study might include expansion of faith-based models to include other denominations and health care providers as well of use of positive influencers to develop future HIV/AIDS intervention strategies.

Making decisions: the process of HIV disclosure for rural African American men.

The purpose of this study was to identify and describe the process of HIV disclosure for rural African American men—a population disproportionately affected by HIV/AIDS. Forty men were interviewed about their experience of making an HIV disclosure. Grounded theory methodology guided data collection and analysis. The core category or variable that emerged from the data was a process—Making Decisions: The Process of HIV Disclosure. Five categories accounted for variations in disclosures: (a) beliefs and knowledge about HIV/AIDS, (b) influencing factors, (c) disclosure decisions, (d) disclosure efficacy, and (e) outcomes of disclosure. Most of the men had disclosed to others; however, the disclosures were selective, and the decisions were iterative. The majority of the men did not disclose their diagnosis for several months to several years. The findings provide a framework of the many factors related to HIV disclosure that can guide health care providers in counseling persons living with HIV/AIDS in making disclosure decisions.

The Evolution of a Community-Based Telepsychiatry Program in Rural Alabama: Lessons Learned—A Brief Report

The purpose of this paper is to describe the partnership between a community-based rural mental health clinic and an academic health center to provide telepsychiatry services in rural Alabama. The partnership was developed to meet the needs of a clinic that serves an underserved rural population with limited psychiatric services. This paper offers valuable lessons learned for mental health practitioners who may be considering the benefits and challenges of forming community-based partnerships in use of telepsychiatry to build capacity to deliver clinical mental health services to rural mental health shortage areas.

Recruitment of rural physicians in a diabetes internet intervention study: overcoming challenges and barriers.

PURPOSE This paper highlights a descriptive study of the challenges and lessons learned in the recruitment of rural primary care physicians into a randomized clinical trial using an Internet-based approach. METHODS A multidisciplinary/multi-institutional research team used a multilayered recruitment approach, including generalized mailings and personalized strategies such as personal office visits, letters, and faxes to specific contacts. Continuous assessment of recruitment strategies was used throughout study in order to readjust strategies that were not successful. RESULTS We recruited 205 primary care physicians from 11 states. The 205 lead physicians who enrolled in the study were randomized, and the overall recruitment yield was 1.8% (205/11231). In addition, 8 physicians from the same practices participated and 12 nonphysicians participated. The earlier participants logged on to the study Web site, the greater yield of participation. Most of the study participants had logged on within 10 weeks of the study. CONCLUSION Despite successful recruitment, the 2 major challenges in recruitment in this study included defining a standardized definition of rurality and the high cost of chart abstractions. Because many of the patients of study recruits were African American, the potential implications of this study on the field of health disparities in diabetes are important.

Bringing Community and Academic Scholars Together to Facilitate and Conduct Authentic Community Based Participatory Research: Project UNITED

Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings.

HIV/AIDS-Related Stigma Among African Americans in the Southern United States

Stigma is defined as a discrediting attribute leading to discrimination. For people with HIV/AIDS, stigma refers to negative feelings and behaviors toward individuals, groups, and communities. Specific African American populations have different stigma-related experiences. This chapter will address stigma in older adults living with the disease as well as the larger community in the rural South. Additionally, because stigma is reported to impact disclosure decisions of HIV-infected individuals, those decisions and their context will be discussed. Also, because spirituality/religion plays an important cultural role in the lives of African Americans, the role of the Black church in HIV/AIDS prevention will also be addressed. The authors will also discuss faith-based strategies to respond in a supportive manner to individuals with HIV/AIDS. The authors draw from their work in the Black Belt region of the rural South, an area with a high incidence and prevalence rates of HIV/AIDS. It is hoped that issues discussed in the chapter will ultimately result in not only positive outcomes for people who are infected but also prevention of infection for others.

Reverse Migration, the Black Church and Sexual Health: Implications for Building HIV/AIDS Prevention Capacity in the Deep South

The Black Church has long been purported as being strongly influential in the lives of Blacks in America. Recent U.S. census data trends highlight a “reverse migration” pattern where Blacks are moving back to the South from larger metropolitan areas in other U.S. geographical regions. This migration pattern parallels the increasing HIV/AIDS prevalence among Blacks in the Deep South. This paper reviews both the historical and current migration patterns among Blacks, as well as the current HIV/AIDS epidemic among Blacks in the Deep South. Thereafter, the authors discuss an existing framework for increasing HIV/AIDS prevention capacity through a conceptual connection of migration, religion and sexual health. The authors use case studies to support the proposed framework. It is hoped that the framework could be used to address HIV/AIDS health disparities and other chronic diseases affecting Blacks in America.

Community-based participatory research-speed dating: an innovative model for fostering collaborations between community leaders and academic researchers

Developing meaningful community-based participatory relationships between researchers and the community can be challenging. The overall success of a community-based participatory relationship should be predicated on commitment and respect from empowered stakeholders. Prior to developing the technique discussed in this article, we hypothesized that the process of fostering relationships between researchers and the community was much like a social relationship: It has to develop organically and cannot be forced. To address this challenge, we developed a community-based participatory research–speed dating technique to foster relationships based on common interests, which we call CBPR-SD. This article describes the logistics of implementing CBPR-SD to foster scholarly collaborations. As part of a federally funded community-based research project, the speed dating technique was implemented for 10 researchers and 11 community leaders with a goal of developing scholarly collaborative groups who will submit applications for community-based research grants. In the end, four collaborative groups developed through CBPR-SD, three (75%) successfully submitted grant applications to fund pilot studies addressing obesity-related disparities in rural communities. Our preliminary findings suggest that CBPR-SD is a successful tool for promoting productive scholarly relationships between researchers and community leaders.